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Conclusions Routine HIV screening with either opt-in or opt- out resulted in at least a 2-fold increase in the percentage of patients offered and undergoing HIV testing compared to risk-based screening In multivariate analysis, MD opt-out screening is associated with greater odds of test acceptance than RN opt-in or RN opt-out screening Increasing age, female sex, and African-American ethnicity were associated with a lower multivariate odds of test acceptance 16

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Limitations Quasi-experimental rather than randomized design –Interventions were fully integrated into clinic care Potential variability in fidelity to interventions –Patient survey data will help determine this Uncertainty about percent eligible for screening at both clinics –Current results may underestimate percent offered testing 17

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Policy Implications Opt-out HIV screening is feasible in community health centers, but does not ensure universal offering of HIV testing –Offer and acceptance rates vary by clinic –Strategies to improve offer rate are needed If RN is offering HIV screening, it may be as effective to use the opt-in method as the opt-out method –Avoid potential problem of coercion Routine HIV screening may not sufficiently increase testing rates for some groups with high prevalence of undiagnosed HIV infection 18

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For More Information Jacqueline Rurangirwa, MPH Epidemiologist Office of AIDS Programs and Policy County of Los Angeles Department of Public Health 19